Antidepressants Associated with Significantly Elevated Risk of Death, Researchers Find

Antidepressant medications, most commonly prescribed to reduce depression and anxiety, increase the risk of death, according to new findings by a McMaster-led team of researchers.

It’s widely known that brain serotonin affects mood, and that most commonly used antidepressant treatment for depression blocks the absorption of serotonin by neurons. It is less widely known, though, that all the major organs of the body–the heart, kidneys, lungs, liver–use serotonin from the bloodstream.

Antidepressants block the absorption of serotonin in these organs as well, and the researchers warn that antidepressants could increase the risk of death by preventing multiple organs from functioning properly.

The researchers reviewed studies involving hundreds of thousands of people and found that antidepressant users had a 33% higher chance of death than non-users. Antidepressant users also had a 14% higher risk of cardiovascular events, such as strokes and heart attacks. The findings were published today in the journal Psychotherapy and Psychosomatics.

“We are very concerned by these results. They suggest that we shouldn’t be taking antidepressant drugs without understanding precisely how they interact with the body,” says author Paul Andrews, an associate professor at McMaster University who led the research team.

Taken by one in eight adult Americans, antidepressants are among the most frequently used medications. They are often prescribed by family doctors without a formal diagnosis of depression, on the assumption they are safe. Since depression itself can be deadly–people with depression are at an increased risk of suicide, stroke and heart attack–many physicians think that antidepressants could save lives by reducing depressive symptoms.

However, McMaster researcher and co-author Marta Maslej, says, “Our findings are important because they undermine this assumption. I think people would be much less willing to take these drugs if they were aware how little is known about their impact outside of the brain, and that what we do know points to an increased risk of death.”

Benoit Mulsant, a psychiatrist at the University of Toronto who was also involved in the study, says the findings point to the need for more research on how antidepressants actually do work.

“I prescribe antidepressants even though I do not know if they are more harmful than helpful in the long-term. I am worried that in some patients they could be, and psychiatrists in 50 years will wonder why we did not do more to find out,” Mulsant says.

Interestingly, the news about antidepressants is not all bad. The researchers found that antidepressants are not harmful for people with cardiovascular diseases such as heart disease and diabetes. This makes sense since these antidepressants have blood-thinning effects that are useful in treating such disorders. Unfortunately, this also means that for most people who are in otherwise good cardiovascular health, antidepressants tend to be harmful.

Source: EurekAlert!


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Statins May Help People With Lung-related Disease Live Longer

Serena Gordon wrote . . . . . .

Drugs known as statins may have benefits beyond lowering “bad” LDL cholesterol levels. A new study suggests people with chronic lung disease who take these drugs may extend their survival.

The study from Canada included nearly 40,000 people with chronic obstructive pulmonary disease (COPD). One in five patients was taking a statin, and those individuals had a 21 percent lower risk of dying from any cause, and a 45 percent reduced risk of dying from lung-related issues, the researchers found.

This study comes on the heels of a separate large-scale investigation that found no link between statin use and the number of COPD exacerbations people experienced.

“While evidence from a recently completed [randomized controlled trial] suggested that statin use is of little benefit to COPD patients, this population-based analysis showed that statin use reduced all-cause mortality among COPD patients,” wrote the study authors led by Adam Raymakers, from the University of British Columbia.

Although statins appeared to give people with COPD a survival benefit, the new study wasn’t designed to prove a definitive cause-and-effect relationship.

Chronic obstructive pulmonary disease includes progressive lung diseases such as emphysema and chronic bronchitis, according to the COPD Foundation. Symptoms include increasing breathlessness, tightness in the chest, coughing and wheezing.

The most common causes for these conditions include smoking and exposure to secondhand smoke. Workplace exposure to chemicals and fumes and genetics may also contribute to COPD.

It’s the third leading cause of death in the United States, according to the U.S. National Heart, Lung, and Blood Institute. Approximately 16 million Americans have been diagnosed with the condition, but many people may have it without knowing it.

Raymakers and his team noted that it’s long been known that people with COPD have inflammation in their lungs. However, it’s also possible that people with COPD — or at least some of them — may have inflammation throughout their body. Inflammation is thought to play a role in many illnesses, including heart disease.

The participants were age 50 and older from British Columbia. The researchers identified people as having COPD if they had received at least three prescriptions for COPD medications in a 12-month period.

The study team then looked to see who was also taking a statin within a year of being labeled as having COPD. Almost 20 percent had received at least one statin prescription.

The researchers adjusted the data to account for a number of factors including age, sex, income and place of residence.

There were almost 1,450 deaths during the one-year study period.

The findings were published in the journal Chest.

Dr. Robert Reed, an associate professor at the University of Maryland School of Medicine, co-authored an accompanying editorial. “Although this is not a perfect paper, it’s really well done, and it showed this benefit to mortality,” he said.

Reed noted that some in the study may not have had COPD.

“They took people who hadn’t been on an inhaler the year before who now had a cough or shortness of breath. That could be a lot of things. They almost certainly had some late-onset asthmatics. People may have even been short of breath for cardiac reasons,” he explained.

“People with COPD have more cardiovascular disease, and treating comorbid [coexisting] conditions can really help out. The survival benefit may not be unique to COPD, but it was a pretty significant survival benefit for people with COPD,” Reed said.

Dr. Len Horovitz, a pulmonary specialist at Lenox Hill Hospital in New York City, said that although study participants got a prescription for statins, it doesn’t necessarily mean they took the drugs.

“There might be a subset of COPD patients who might benefit from statin use who don’t need a statin for cardiovascular reasons, but the heart and lungs are intertwined, and it’s hard to tease out someone with COPD who doesn’t have risk factors for cardiovascular disease,” Horovitz said.

Because most people with COPD are smokers or former smokers, he said, most also have cardiovascular disease. “And that cardiovascular disease is usually reason enough to prescribe the statin,” he added.

Source: HealthDay


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Statins Help Healthy People Lower Their ‘Bad’ Cholesterol

Cholesterol-lowering statins reduce the risk of heart disease and death in otherwise healthy people who have very high levels of “bad” LDL cholesterol, a long-term study finds.

For 20 years, more than 5,500 men in Scotland who did not have heart disease but who had high levels of LDL took 40 milligrams of pravastatin, a relatively weak type of statin, daily. Doing so reduced their overall risk of death by 18 percent, the risk of death from heart disease by 28 percent, and the risk of death from other cardiovascular diseases by 25 percent.

“For the first time, we show that statins reduce the risk of death in this specific group of people who appear largely healthy, except for very high LDL levels,” said study senior author Dr. Kausik Ray, a professor in the School of Public Health at Imperial College London.

The findings challenge taking a “watch-and-wait” approach in younger patients with elevated LDL levels, according to the researchers. They said even people with slightly elevated cholesterol have a higher long-term risk of heart disease.

“This is the strongest evidence yet that statins reduce the risk of heart disease and death in men with high LDL,” Ray said in a college news release.

“Our study lends support to LDL’s status as a major driver of heart disease risk, and suggests that even modest LDL reductions might offer significant mortality benefits in the long term,” Ray concluded.

The study was published in the journal Circulation.

Source: HealthDay


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Too Many Meds? America’s Love Affair With Prescription Medication

Teresa Carr wrote . . . . . .

If you’re like most Americans, you probably start your day with a hot shower, a cup of coffee—and a handful of pills.

More than half of us now regularly take a prescription medication—four, on average—according to a new nationally representative Consumer Reports survey of 1,947 adults. Many in that group also take over-the-counter drugs as well as vitamins and other dietary supplements.

It turns out Americans take more pills today than at any other time in recent history (see “Pill Nation: The Rise of Rx Drug Use”)—and far more than people in any other country.

Much of that medication use is lifesaving or at least life-improving. But a lot is not.

The amount of harm stemming from inappropriate prescription medication is staggering. Almost 1.3 million people went to U.S. emergency rooms due to adverse drug effects in 2014, and about 124,000 died from those events. That’s according to estimates based on data from the Centers for Disease Control and Prevention and the Food and Drug Administration. Other research suggests that up to half of those events were preventable.

All of that bad medicine is costly, too. An estimated $200 billion per year is spent in the U.S. on the unnecessary and improper use of medication, for the drugs themselves and related medical costs, according to the market research firm IMS Institute for Healthcare Informatics.

Our previous surveys have found that higher drug costs—including more expensive drugs and higher out-of-pocket costs—also strain household budgets, with many people telling us they had to cut back on groceries or delay paying other bills to pay for their prescriptions.

The nation’s expensive and harmful pill habit comes in several forms:

Taking too many drugs. Nicole Lamber of Williamsburg, Va., says she became “completely nonfunctional”—with pain, rashes, diarrhea, and anxiety—from the adverse effects of several drugs, including some her doctors prescribed to treat side effects from her initial prescriptions.

Taking drugs that aren’t needed. Jeff Goehring of Waukesha, Wis., suffered a debilitating stroke shortly after he began taking testosterone, which his doctor prescribed for fatigue even though the Food and Drug Administration hadn’t approved it for that use, according to a lawsuit he’s involved in.

Taking drugs prematurely. Diane McKenzie from Alsip, Ill., had regular bouts of diarrhea and vomiting, side effects she attributed to the drug metformin, which her doctor prescribed for “prediabetes,” or borderline high blood sugar. But McKenzie found that losing weight controlled her blood sugar levels without drugs.

Why would so many people take so many potentially harmful pills?

Partly because while all drugs pose some risks, they’re often essential, treating otherwise deadly or debilitating diseases, notes Andrew Powaleny, director of public affairs for the Pharmaceutical Research and Manufacturers of America (PhRMA), a trade group.

To be sure, some people—especially those who are uninsured or underinsured—don’t get all of the care they need, including medication.

Still, many Americans—and their physicians—have come to think that every symptom, every hint of disease requires a drug, says Vinay Prasad, M.D., an assistant professor of medicine at Oregon Health & Science University. “The question is, where did people get that idea? They didn’t invent it,” he says. “They were spoon-fed that notion by the culture that we’re steeped in.”

It’s a culture, say the experts we consulted, encouraged by intense marketing by drug companies and an increasingly harried healthcare system that makes dashing off a prescription the easiest way to address a patient’s concerns.

To investigate this growing problem and to help you manage your drugs, we sought expert advice on how to work with doctors and pharmacists to analyze your drug regimen. We reviewed the drug lists submitted by 20 Consumer Reports readers to see whether we could find problems, and alerted them when we did. We also dispatched 10 secret shoppers to 45 drugstores across the U.S. to see how well pharmacists identify potentially problematic drug interactions. And last, we compiled a list of 12 conditions that are often first treated with drugs—but usually don’t need to be.

A Growing Tide of Risk

Nicole Lamber’s problems started with a single prescription medication when, stressed in her first job as a physician’s assistant, a physician colleague prescribed alprazolam (Xanax). “I wasn’t given any warning about anything at all, it was just presented as a safe drug,” she says. Within a few months, Lamber, who is now 38, was depressed, even suicidal. “It scared me,” she remembers.

Over the next five years, Lamber says she saw a series of doctors who prescribed more and more drugs: the ADHD medication Adderall to lift her mood and help her focus; another to counter the side effects of that drug; others to improve her appetite and help her sleep; and when her anxiety worsened, another sedative.

The combination, she says, made her so ill she couldn’t leave the house. “I saw tons of specialists,” she recalls. “A gastrointestinal doctor for chronic diarrhea, an orthopedist and rheumatologist for joint pain, a dermatologist for rashes. None of them questioned my list of meds.”

Lamber’s story is hardly unique: The percentage of Americans taking more than five prescription medications has nearly tripled in the past 20 years, according to the Centers for Disease Control and Prevention. And in our survey, over a third of people 55 and older were taking that many drugs; 9 percent were taking more than 10.

In some cases, multiple drugs are “completely appropriate,” says Michael Hochman, M.D., of the Keck School of Medicine at the University of Southern California. But as the number of drugs piles up, so does the need for caution. “The risk of adverse events increases exponentially after someone is on four or more medications,” he says.

That’s especially true when multiple doctors are involved. Poor communication between providers often contributes to drug errors, says Michael Steinman, M.D., at the University of California, San Francisco School of Medicine. And seeing more than one doctor is now the norm: 53 percent of those in our survey taking prescription medications said they received them from two or more providers.

Potentially harmful prescribing is all too common, says Steven Chen, Pharm.D., an associate dean for clinical affairs at the University of Southern California School of Pharmacy, who worked with Consumer Reports to review the medication lists submitted by readers. (Chen, like many pharmacists reviewing drugs, didn’t have access to medical records.) Of the 20 lists he reviewed, only two received a clean bill of health. Among the other 18, Chen identified 38 potential problems, half of which he considered serious. They included one person taking a combination of blood-pressure drugs that could cause potassium levels to spike and trigger dangerous heartbeat abnormalities, and another’s mix of a blood thinner, a pain reliever, and baby aspirin that could cause stomach bleeding.

Identifying those kinds of risks and untangling potential harmful interactions can be difficult.

For Lamber, it meant finding a doctor who was willing to help. Still, stopping the drugs was a long, “nightmarish” process, she says, because she had become physically dependent on them and it triggered painful withdrawal symptoms. Today, while some side effects linger, she says she feels lucky to be alive. “The drugs—and the withdrawal from them—almost killed me,” she says.

Selling Sickness

Jeff Goehring, now 55, ran a busy deli and snow-plowing business in 2009 when he says he started feeling more tired than usual. He decided to see a doctor who, he says, prescribed AndroGel, a drug containing the male hormone testosterone.

Goehring says he didn’t know then that testosterone drugs are approved by the FDA only for men with hypogonadism, or very low levels of testosterone, usually caused by infection, injury, or other health problems. He also says he wasn’t warned that testosterone increases the risk of a heart attack or stroke, according to the FDA.

After four days applying the drug, Goehring suffered a stroke, according to a lawsuit he is part of against AbbVie, AndroGel’s maker. He’s one of more than 6,000 people nationwide suing six drug companies that make testosterone products, claiming that they suffered a heart attack, stroke, or other cardiovascular event after using one of the drugs.

In a statement to Consumer Reports, AbbVie said the company believes “our disease education and marketing of AndroGel have adhered strictly to FDA-approved uses,” and emphasized that it’s up to each physician to make sure the drug is used for appropriate purposes.

So why would Goehring’s doctor put him on a medication that may not have been indicated for his condition? For one thing, doctors can prescribe drugs for such off-label uses even if the FDA hasn’t reviewed the evidence and approved the drug for those purposes, explains Stephanie Caccomo, a spokeswoman for the agency.

For another, about the time Goehring started on testosterone, pharmaceutical companies began investing heavily in ads for the drugs and even came up with a catchy new name: “low T.” Spending on the ads rose quickly, to $153 million in 2013. And companies got a lot of bang for their advertising buck. A March 2017 study in JAMA found that between 2009 and 2013, men exposed to more TV ads for testosterone or “low T” were much more likely to wind up on the drug.

Those “low T” figures are a drop in the bucket. Total spending on drug ads targeting consumers reached $6.4 billion last year, 64 percent more than in 2012, according to Kantar Media, a market research company. That’s $1.3 billion more than the FDA’s entire 2017 budget. Drug companies spend even more—$24 billion in 2012 alone—on marketing just to doctors through ads in medical journals, face-to-face sales, free medication samples, and educational and promotional meetings, according to a report from the Pew Charitable Trusts.

Building relationships with healthcare providers and marketing medicines is valuable, says Powaleny, the spokesman for PhRMA, helping to ensure “that healthcare professionals have the latest, most accurate science-based information available regarding prescription medicines.”

But many drug-safety experts worry that the practice also contributes to overmedication.

“Low T is a marketing term intended to sell testosterone as a kind of fountain of youth,” says Steven Woloshin, M.D., a professor at the Dartmouth Institute of Health Policy and Clinical Practice. For most men, he says, testosterone “declines naturally with age,” and research shows that taking drugs to compensate has “little or no benefit” and “some serious risks.”

That’s something Goehring wishes he had understood better. His stroke, he says, still impairs his short-term memory and has left one of his hands partially numb, forcing him to close his deli. Now, eight years later, he’s still trying to pay off hospital bills not covered by insurance.

The Rise of ‘Predisease’ Diagnoses

Two years ago, Diane McKenzie’s doctor recommended metformin (Glucophage) to treat a blood sugar level that put her at the high end of normal but still below the cutoff for diabetes. Concerned about developing the full-blown disease, McKenzie, then 44, agreed to take it. But almost immediately, she began to suffer from diarrhea and vomiting, known side effects.

Her experience illustrates another trend that’s putting more people on drugs: diagnosing them in the “predisease” stage of a condition. For example, identifying people with mild bone loss (osteopenia, or preosteoporosis), slightly elevated blood pressure (prehypertension) or, as in McKenzie’s case, prediabetes, a slightly elevated—but still normal—blood glucose reading.

Catching disease early, of course, can be a good thing if it helps you address a problem before it leads to serious harm.

But “lowering the bar for what’s considered normal” can also get people on drugs before they need to be, says Allen Frances, M.D., a professor emeritus at Duke University who studies how the medical profession sometimes expands the definition of diseases. And treating people with drugs at the very early stage of a condition “often harms more people than it helps,” Frances says.

That’s what McKenzie, a nurse practitioner, says she worried about when she began experiencing side effects. After a few months, they were so intolerable she stopped taking metformin.

Research actually supports that approach. A 2015 study in Lancet Diabetes & Endocrinology found that for people with prediabetes, regular exercise plus a low-calorie, low-fat diet cut the incidence of developing type 2 dia­betes by 27 percent; metformin lowered it by 18 percent. And the side effects of exercise and a healthy diet are other health benefits, not diarrhea and vomiting.

McKenzie decided to make lifestyle changes to lower her blood sugar. Key to her success, she believes, is the stray puppy she adopted, who motivated her to take long daily walks, helping her lose 70 pounds. Today McKenzie’s blood sugar levels are under control.

Doctors Who Know When to Say No

Ranit Mishori, M.D., a professor of family medicine at the Georgetown University School of Medicine in Washington, D.C., made it her New Year’s resolution this year to prescribe fewer drugs.

She’s part of a trend called “de-prescribing,” or focusing on keeping patients healthy by getting them off unnecessary drugs. “In med school we’re taught how to prescribe, not how to take people off drugs,” she says.

Another doctor who de-prescribes is Victoria Sweet, M.D., who spent 20 years at a charity hospital in San Francisco with few high-tech resources but lots of time for patients. “There’s a big push in our country to practice medicine as if we are fixing machines with a broken part,” says Sweet, author of a forthcoming book, “Slow Medicine: The Way to Heal.” “Take the pill, fix the symptom, move on,” she says. “Slow medicine” means “taking time to get to the bottom of what’s making people sick—including medications in some cases—and giving the body a chance to heal.”

Some groups are trying to help that approach go mainstream. Through the Choosing Wisely initiative (Consumer Reports is a partner), more than two dozen medical organizations have made recommendations that involve dialing back the use of unneeded drugs.

And some medical organizations, such as the American College of Physicians, now advise doctors to try nondrug approaches first for certain conditions. For example, the ACP recommends usually treating back pain first with massage, spinal manipulation, or other nondrug options.

But for the system to change, insurance needs to evolve, too, says Cynthia Smith, M.D., vice president of clinical programs at the ACP. “A patient’s out-of-pocket costs are currently significantly less with medical therapy” than with nondrug options, she notes. “We need to make it easier for both doctors and patients to do the right thing.”

Source: Consumer Report

12 Situations to Try Lifestyle Changes Before Medication

Teresa Carr and Ginger Skinner wrote . . . . . . .

Americans often rush—or get rushed—into taking drugs too quickly.

Sometimes doctors prescribe them for problems—back pain, heartburn, and insomnia, for example—without first giving lifestyle changes a chance.

Or they diagnose people when they’re in the “predisease” stage of a condition—think mild bone loss or slightly elevated blood pressure or blood sugar levels—and immediately start treating them with drugs when simple steps are often enough.

Here, 12 such situations, and what to do instead.

1. ADHD

Drugs: Antipsychotics such as Abilify and Seroquel.

Risks: Side effects include constipation, difficulty breathing or swallowing, dizziness, drowsiness, fast or irregular heartbeat, fever, seizures, and weight gain.

Nondrug options: Behavioral therapy plus educational interventions and exercise. (In some cases, a stimulant such as Adderall or Ritalin may also be necessary, but first consult with a specialist.)

When to consider a drug: Antipsychotics should be used for ADHD only if other psychiatric conditions are diagnosed, such as bipolar disorder.

2. Back & Joint Pain

Drugs: Nonsteroidal anti-inflammatories such as Advil, Aleve, and Celebrex; opioids such as OxyContin and Percocet.

Risks: High doses or long-term use of Advil and related drugs can cause bleeding in the intestines, kidney failure, heart attack, ulcers, and stroke. Opioids can trigger drowsiness, nausea, vomiting, constipation, addiction, and overdose.

Nondrug options: Try yoga, swimming, gentle stretches, tai chi, massage, physical therapy, acupuncture, or heat.

When to consider a drug: Anti-inflammatories are okay for short-term flare-ups, though even then stick with a low dose and don’t take them for longer than 10 days without talking with your doctor. Opioids should be a last resort and prescribed at the lowest effective dose for the shortest time possible.

3. Dementia

Drugs: Antipsychotics such as Abilify and Seroquel.

Risks: Generally the same as those listed for ADHD, as well as stroke and death.

Nondrug options: Establish a regular routine, do calming activities, and have frequent social contact. It’s also a good idea to rule out underlying conditions that can sometimes lead to disturbed behavior, such as constipation, infection, or hearing or vision problems.

When to consider a drug: If the patient suffers from delusions, hallucinations, or other serious mental illness, or presents a danger to himself or others.

4. Mild Depression

Drugs: Antidepressants such as Celexa, Cymbalta, Lexapro, and Prozac.

Risks: Many side effects, including diarrhea, drowsiness, headaches, agitation, sexual dysfunction, and suicidal thoughts.

Nondrug options: Exercise, meditation, and various forms of talk therapy.

When to consider a drug: If therapy alone isn’t enough or depression is severe. Reassess after six weeks and consider switching drugs if you aren’t getting better.

5. Heartburn

Drugs: Proton-pump inhibitors (PPIs) such as Nexium, Prevacid, and Prilosec.

Risks: Reduced stomach acid, which impairs the body’s ability to absorb certain nutrients and medication, and increases the risk of gastrointestinal and other infections. Long-term use may increase the risk of fractures, dementia, heart attack, and kidney disease.

Nondrug options: Eat smaller meals, don’t lie down soon after eating, lose excess weight, and avoid trigger foods, including acidic or greasy meals. For occasional heartburn, try OTC products such as Maalox, Pepcid AC, Tums, or Zantac 75.

When to consider a drug: If heartburn occurs twice weekly or more for four weeks or longer and your doctor diagnoses gastroesophageal reflux disease, which occurs when stomach acid backs up into the esophagus and damages it. In that case, consider a PPI for a few months while your esophagus heals.

6. Insomnia

Drugs: Sleeping pills such as Ambien, Belsomra, and Lunesta.

Risks: Dizziness, next-day drowsiness, impaired driving, dependence, and worsened sleeplessness when you try to stop.

Nondrug options: Cognitive behavioral therapy (CBT) for insomnia, where a provider teaches you good sleep habits and suggests ways to change your behavior, such as cutting out naps or not using your laptop in bed.

When to consider a drug: If you have short-term sleep problems caused by a stressful event such as a death in the family or a divorce, or if CBT alone doesn’t provide enough relief.

7. Low Testosterone

Drugs: Testosterone topicals (such as AndroGel and Axiron), patches (Androderm), and injections (Aveed).

Risks: Blood clots in the legs, sleep apnea, an enlarged prostate, and possibly an increased risk of a heart attack or stroke. Topical forms can transfer to others, causing the growth of body hair in women and, if pregnant, transfer the hormone to their babies. Children exposed to the hormone have experienced enlargement of the penis or clitoris, the growth of pubic hair, an increased libido, and aggressive behavior.

Nondrug options: Treat conditions that can decrease testosterone, such as diabetes or obesity. Also discuss nondrug ways to boost energy and vitality by exercising, getting enough sleep, and couples therapy with your partner.

When to consider a drug: If you have hypogonadism, which is very low testosterone levels caused by a genetic disorder; damage to the testicles from injury or chemotherapy; or another cause.

8. Osteopenia, or Preosteoporosis (Bone Density at the Low End of Normal)

Drugs: Bisphosphonates such as Actonel, Boniva, and Fosamax.

Risks: Diarrhea, nausea, vomiting, heartburn, esophageal irritation, and bone, joint, or muscle pain. Long-term use may increase the risk of thigh fractures.

Nondrug options: Consume foods high in calcium and vitamin D, do weight-bearing exercises such as walking or lifting weights, and quit smoking. Plus take steps to prevent falls by, for example, avoiding sleeping pills and installing grab bars in the bathroom.

When to consider a drug: If bone-density tests show you have full-blown osteoporosis. Even then, consider taking a break after five years to reduce the risk of lasting side effects.

9. Overactive Bladder (Sudden or Frequent Need to Urinate)

Drugs: Anticholinergics such as Detrol and Oxytrol.

Risks: Constipation, blurred vision, dizziness, confusion, and an increased risk of dementia.

Nondrug options: Cut back on caffeine and alcohol, and try bladder training (slowly increasing the time between bathroom visits) and Kegel exercises (repeatedly tightening and relaxing the muscles that stop urine flow).

When to consider a drug: If several weeks of nondrug strategies don’t provide enough relief.

10. Prediabetes (Blood Sugar Levels at the High End of Normal)

Drugs: Blood-glucose-lowering drugs such as Actos and Glucophage.

Risks: Dizziness, tiredness, muscle pain, and in rare cases other symptoms caused by a dangerous buildup of lactic acid and a vitamin B12 deficiency.

Nondrug options: Exercise, eat a healthy diet rich in nonprocessed and nonstarchy foods, and lose weight.

When to consider a drug: If you develop full-blown type 2 diabetes.

11. Prehypertension (Blood Pressure at the High End of Normal)

Drugs: ACE inhibitors, angiotensin receptor blockers (ARBs), calcium channel blockers, and diuretics.

Risks: Diuretics can cause frequent urination, low potassium levels, and erectile dysfunction. ACE inhibitors and ARBs can cause high potassium levels and reduced kidney function. Calcium channel blockers can cause dizziness, an abnormal heartbeat, flushing, headache, swollen gums, and less often, breathing problems.

Nondrug options: Quit smoking, cut back on sodium and alcohol, lose excess weight, and exercise.

When to consider a drug: If you develop true hypertension.

12. Obesity

Drugs: The weight-loss drugs Belviq, Contrave, Qsymia, and Xenical.

Risks: Constipation, diarrhea, nausea, or vomiting are common. The drugs also cause rare but dangerous side effects, including leaky heart valves with Belviq and liver damage with Xenical.

Nondrug options: If you’ve been unable to lose weight on your own by exercising more and eating less, ask your doctor about formal weight-loss programs.

When to consider a drug: If lifestyle changes have failed and you are obese or overweight and have heart disease or type 2 diabetes. If you haven’t lost at least 5 percent of your weight after three months, stop because it’s unlikely to help.

Source: Consumer Report